Case formulations on selected mental disorders by clinical psychologists and traditional health practitioners: a comparative analysis

Abstract

With the realisation that both the traditional and western health care systems are consulted in South Africa, the Traditional Health Practitioners Act, No 22 of 2007 was promulgated. In addition to the Act, there was a growing body of literature proposing the integration of the two health systems to improve the overall South African health system. This study explored the possibility for such collaboration by investigating case formulation by western-trained clinical psychologists and traditional health practitioners regarding selected cases of mental disorders. A qualitative research design, specifically a case study method was used in the present study. Six clinical psychologists and six traditional health practitioners were selected through purposive sampling and were requested to participate in the study. The researcher further sampled two vignettes of Major Depressive Disorder and Schizophrenia for data collection purposes. Data was collected through semi-structured interviews and vignettes and analysed through Braun and Clarke‟s thematic content analysis steps. Six main themes that related to case formulations by clinical psychologists emerged. These themes were: a). Collateral information as a major determinant in the assessment and treatment of mental illness; b). Classifications of mental illness; c). The symptomatology of mental illness; d). Causes of mental illness; e). The multidisciplinary approach in the treatment of mental illness; and f). Views regarding the collaboration of Clinicians and Traditional Health Practitioners. On the other hand, eight themes that related to the case formulations by traditional health practitioners were identified. These themes were: a) Divination as the main process of enquiry, b) Descriptive names of mental illnesses, c) Conceptualisations of stress related and depressive disorders by Traditional Health Practitioners, d) Views on causes of mental illness, e) The effectiveness of the Western approach in the treatment of some forms of mental illness, f) The relationship between religion and African traditional practices; g) A calling as symbolised by symptoms of mental illness, and, h) Traditional health practitioners‟ views on the collaboration between themselves and western health practitioners. The study has further revealed that there are some similarities as well as differences in the way clinical psychologists and traditional health practitioners formulate cases. The convergences in their formulations were revealed in the following themes; a). The conceptualisation of stress and related conditions; b). The western system is the most appropriate in the management of stress-related and depressive disorders and c). The benefits of the collaboration between western and African healing systems. The following divergences were further identified from the way clinical psychologists and traditional health practitioners formulate their cases: a). The conceptualisation of the presenting symptoms from the two cases; b). The causal factors of mental health conditions; c). The initial methods of enquiry; and d). The management of mental health conditions. The study has further revealed that both traditional health practitioners and clinical psychologists have positive views regarding the collaboration of western and African traditional health systems, especially in the management of mental disorders. The study has further uncovered the convergences and divergences in the conceptualisation of mental health conditions between traditional health practitioners and clinical psychologists.